Care Plan Appropriateness

Transcription

1 Care Plan Appropriateness Accurate Assessment Focused Care October 17, 2012 Director All Hands Pillar Breakout Series

2 Aligning our Work Strive to provide the very best service to our clients. Set specific goals and work hard and efficiently to achieve them.. -The BAYADA Way Page 2

3 This Session Objectives At the end of this session you will: Gain additional insight into how two divisions have structured the Care Plan Review process: Review process supported with the DCO role Review process supported through the Divisional Director / Director role Page 3

4 Why Spend Time Talking About CPR Page 4

5 Inquisitive - Not Prescriptive The assessment should guide our interventions. are our goals and plan in alignment with the assessed need We should constantly be asking if our goals are in alignment with the assessed need Page 5

6 Developing the Patient Care Plan Steps to Developing the Patient Specific Care plan Prior to Review Evaluation Documentation Review Referral Pages / Continuing Care Documents / Bayada Referral Homebound, Skilled Need / Medical Necessity Necessity Diagnoses, Reason for hospitalization/referral Comorbidities that may affect care plan Medications- indicate other diagnoses Consider risks of re-hospitalization CMS penalty dx, falls, meds & noncompliance Allergies, Diet, DNR Therapy DC Assessments, Rehab Potential Self Care Abilities/Levels of assist with ADL s Self Care Abilities/Levels of assist with ADL s? Services requested appropriate ex. Shoulder dislocation- no OT requested HHA requested- No OT requested CHF patient- no OT- energy conservation Page 6

7 Developing the Patient Care Plan SOC Conference Call with Clinician Review Homebound & skilled need Primary & Secondary DX s Skilled Interventions Risk for Rehospitalization Acuity & Functional deficits Visit plan (# of visits & plan for each visit) Plan to recert High Risk ACH CMS penalty Diagnoses Patient Pacing Page 7

8 Developing the Care Plan Tools Your review from Referral documents SOC Oasis Therapy Evals Review CFS Score Review OCS Guidelines on Home Health Utilization Summary MCM Overview RN Coder- reviewing the Care Plan Set GM % bar for from Coder triggering additional discussion re care plan appropriateness with Director, CM. 90% of the time there is opportunity to improve our care plan Examples of MCM Care Plan Inquiries Locked and GM is 64-there are 11 ordered nursing visits/national average is 9.9 and there are 20 ordered aide visits/national average is 2.2 Locked and GM is 67-there are 10 ordered nursing visits/national average is 6.7 Locked and GM is 36-there are 16 aide visits/national average is 2. These HHA visits will be removed due to changes in plan there will only be 6 Page 8

9 Developing the Care Plan General Nursing Utilization Guideline C1 1-2 nursing visits C2 2-4 nursing visits C3 3-5 nursing visits Exceptions- Patient Specific Consult with Clinician- must be clinically based exceptions ICD 9 s that drive increased visits 707, 800, 900 Wounds, Pressure Ulcers, Complications No evidence that increased # of visits improves patient outcomes. In Summary 1. Review Referral Documents 2. In HCHB Review: 485 order- quick look SOC Visit Note/Assessment & Coordination Notes Edit Oasis- see CFS score Check Oasis answers Home Health Utilization Summary Pulls all the data together? Visit Utilization appropriate based on your clinical review 3. Consult with SOC Clinician- SOC conference. 4. Complete task steps for 485 and Send to MCM! Page 9

10 Clover Division: It Takes a TEAM! THE CLINICAL MANAGER SOC process Weekly/ongoing process CLINICAL MANAGERS PEER TO PEER Biweekly interactive conference calls DIRECTOR/DCO/CLINCIAL MANAGER Biweekly office meeting DIVISION DIRECTORS BIWEEKLY CALL Directors & DCO led by Jean Ritter Page 10

11 Clinical Manager Ensure appropriateness at SOC using the HOME HEALTH UTILIZATION SUMMARY TOOL on the SOC task ladder Page 11

12 Clinical Manager It Starts at the Start Page 12

13 Clinical Manager Follow-up Process HOME HEALTH UTILIZATION REPORT DAILY / WEEKLY STANDUP IN REVIEW( missed visits, TIF etc.) Page 13

14 Clinical Managers: Peer-to-Peer BIWEEKLY CALLS Structured Peer to peer case presentation and discussion Patient and discipline pacing, patient selfmanagement Review of supporting documentation/therapy progress graphs Review of other CM processes Page 14

15 Director /Clinical Manager / DCO Biweekly Office Meeting Agenda REVIEW OF KPI S : TABLEAU HH Medicare Key Metrics DCO Daily/Weekly stand up in review Care Plan Review Review in HCHB Report Manager: Review of active caseload for recertification needs Recerts: examine high utilization; identify : Diagnoses with long recovery curves( recent CVA/ hip fractures) Chronic diseases with expected decline( CA/Alzheimer's) Cases with a history of multiple rehospitalizations within cert or in past episodes Page 15

16 Director /Clinical Manager / DCO Top 5 Reasons why your office must master Care Plan Appropriateness: #5. Because you can! Finally, no more chasing paper, Bayada Boulevard, open paperwork in RN s trunk. #4. Because CPR is really the Holy Grail for HH, we ve been trying to get here since the dawn of home health. #3. Because once successful, less mismatched episodes will come in from the field and require action. #2. Because success is very unlikely if you don t do this process consistently well. #1. Because Bill Dombi pretty much said we better. Page 16

17 Director /Clinical Manager / DCO Key Concepts of the Process: The CPR process will be an exercise in futility if LEARNING doesn t occur; DCOs impart knowledge to CMs, and CMs impart the same concepts to field case managers and the rest of the clinical team. In a perfect world, this process would occur primarily in the field. In many cases, the CSM is in a great position to help e.g. scheduling, missed visits, days between Evaluation and visit #2. Page 17

18 Director /Clinical Manager / DCO Tools from CM Training Day: Language for Clinical Managers to use with clinicians once there is a mismatch: What do we hope to accomplish; big picture view from field case manager to Clinical Manager. Is there another way to get there; is there a more efficient manner to reach the desired outcome. Wow! This is looking like a 2 cert period client- what do you think; forces clinicians to think. What would you do if this were a managed care patient; clinician driven ways to do more with less. Do you think the team can meet the client goals with this intensity; forces big picture review of POC. Page 18

19 Director /Clinical Manager / DCO Take Home Points Day after White Shoes prepared your CMs to have these conversations; we promised them support from their Directors and Division Directors. Care Plan Review Dashboard shows all visits out there; make sure field staff plot only what they believe the client will need so that the actual plan can be evaluated for appropriateness. At hire, we recommend bringing up this concept with all potential field staff hires: At Bayada, client care is determined in a collaborative manner, meaning that field clinicians of all disciplines collectively determine the best overall plan of care and ultimately utilize the Clinical Manager (often a nurse) to concur with the plan How do you feel about vetting your discipline s plan of care through the team and the Clinical Manager? Page 19